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Query: UMLS:C0917816 (mental retardation)
 15,867 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The current status of pharmacological treatments of self-injurious behavior (SIB) and aggression in persons with mental retardation and autism was reviewed in the literature. Much of the existing literature is derived from anecdotal clinical experience, with a relative lack of well-controlled studies to determine the efficacy of different treatments. Although all psychotropics have been used to manage SIB and aggression, particularly promising are the data on the use of opioid antagonists like naltrexone. Beta-blockers may also have some role, but more controlled, systematic studies are needed. Use of neuroleptics is on the decline because of their adverse effects, such as tardive dyskinesia and possible impairment of cognitive functions. We assert that the behavioral problems of SIB and aggression are at times manifestations of different psychiatric syndromes. They present in a modified, atypical form in the developmentally disabled population because of cognitive limitations. Further understanding and classification of the psychopathology associated with this behavior is essential for its successful treatment.
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PMID:Self-injurious behavior in the developmentally disabled: pharmacologic treatment. 129 22

Self-injurious behavior is a serious problem that is not uncommon among individuals with mental retardation. Medical and developmental characteristics of 97 children, adolescents, and young adults (age range 11 months to 21 years, 11 months) assessed and treated for self-injurious behavior in a specialized, interdisciplinary inpatient unit between 1980 and 1988 were reviewed. This population differed from those reported in previous studies in that it was of school age and predominantly community based. Severe or profound mental retardation was present in 82.5% of our patients. The causative diagnoses associated with self-injurious behavior were similar to those of severe mental retardation alone. Associated disabilities represented at greater than expected frequencies included pervasive developmental disorders, visual impairment, and a history of infantile spasms. Most patients (81.4%) engaged in more than one type of self-injurious behavior. The most common topographies were head banging, biting, head hitting, body hitting, and scratching. Physical injury was documented in 77% of cases; the injuries most frequently reported were excoriations, scars/callus formation, hematomas, and local infection. As community placement of handicapped individuals continues to increase, pediatricians will be called upon to monitor patients who engage in self-injurious behavior.
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PMID:Children with self-injurious behavior. 230 6

When tested in rats supersensitive to dopamine agonists, the atypical neuroleptic clozapine displayed pharmacological properties expected of both a D-1 and D-2 receptor antagonist. The locomotor response induced by the D-1 receptor agonist SKF-38393 in neonatal-6-hydroxydopamine (6-OHDA)-lesioned rats was reversed in a dose-related fashion, although a complete blockade of this behavior was not observed indicative for only a partial antagonism of D-1 receptor function. Clozapine also blocked the self mutilation resulting from L-dihydroxyphenylalanine (L-DOPA) administration to neonatal-6-OHDA-lesioned rats, an effect previously linked to D-1 receptor activation. At higher doses, clozapine blocked the locomotor activity elicited by the D-2 agonist LY-171555 in adult-6-OHDA-lesioned rats. Therefore, the action of clozapine on D-1 as well as D-2 receptor-mediated behaviors contributes to its pharmacological effects. The ability of clozapine to stop self-mutilatory behavior in neonatal-6-OHDA-lesioned rats suggests that this drug might be an effective treatment for self-injurious behavior associated with the Lesch-Nyhan syndrome and mental retardation.
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PMID:Clozapine antagonism of D-1 and D-2 dopamine receptor-mediated behaviors. 249 73

Autism is a severe form of childhood psychopathology first described by Leo Kanner in 1943. While over the years there has been substantial controversy about many features of the syndrome, there is today some consensus as to the behavioral characteristics associated with the diagnosis. These include onset of the disorder in the early preschool years, severe and pervasive deficits in social behavior and attachments, deficits in speech and language, insistence for the preservation of sameness, unusual responsiveness to the sensory environment, self-stimulation, self-injurious behavior, isolated skill areas, and inappropriate affect. Another associated feature of many cases of autism is mental retardation. The present article describes these behavioral features as well as the application of the diagnosis and differentiation of autism from other disorders including primary mental retardation, childhood schizophrenia, developmental aphasia, and pervasive developmental disorder.
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PMID:Diagnostic features of autism. 305 87

An inherited complete deficiency of hypoxanthine-guanine phosphoribosyltransferase in male children is associated with a severe neurological disorder characterized by chloroform and athetoid movements, hypertonicity, mental retardation, and self-injurious behavior. In the review that follows several possible mechanisms by which the enzyme defect may cause the CNS disorder are discussed. Current evidence suggests that the primary neural deficit in the Lesch-Nyhan syndrome is a deficiency of dopamine in the basal ganglia. It is argued that this neurochemical lesion results from a deficiency of purine nucleotides which impairs arborization of nigrostriatal neurons during perinatal development. Differences in the ontogenetic timing of the neurochemical lesion may be partly responsible for the different neurological symptoms displayed by persons afflicted with the Lesch-Nyhan and Parkinson's syndromes.
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PMID:The biochemical basis of the behavioral disorder in the Lesch-Nyhan syndrome. 392 93

Sixteen severely self-injurious residents of a state mental retardation facility were treated with conventional, non-aversive behavior modification techniques by the same staff over a four-year period. Although each resident had performed multiple self-injuries prior to treatment, including blindness, multiple permanent scars, punctured eardrums, etc., 12 of the 16 improved in terms of decreased frequency of self-injurious behavior (SIB) and decreased frequency of measurable physical injury; of these, seven ceased SIB altogether. Each resident's treatment was unique, which necessitated unique analyses of controlling antecedents and maintaining consequences. Two exclusive types of self-injurious residents became evident: a) those whose SIB was maintained by socially reinforcing consequences and b) those whose SIB was maintained by escape contingencies. The study suggests that in agencies where intensely aversive techniques cannot be used to treat SIB, occasional restraint control of behavior can be combined with intensive differential reinforcement of other (DRO) or incompatible (DRI) behavior to produce an extended but satisfactory probability of successful treatment. Similar to published results from intensely aversive treatment, mildly aversive treatment, which largely depended upon positive reinforcement of desirable alternative behaviors, did not completely suppress the most severe SIB.
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PMID:Nonaversive treatment of severe self-injurious behavior: multiple replications with DRO and DRI. 716 65

The behavior of staff who care for people with mental retardation has been identified as a significant factor in the development and maintenance of challenging behaviors. In a recent analysis, Hastings and Remington (1994a) suggested that both environmental contingencies and rules from other people may affect staff actions. The present study tested this analysis by asking participants to respond to a computer simulation of a work situation involving the care of two individuals who engaged in self-injurious behavior. Fifty participants "interacted" with an attention-seeker and a social-avoider on a simulated teaching task. Results showed that rules were the main factor governing performance. The aversive nature of the contingencies between the self-injury and participants' "attending" behavior also appeared to be influential. The implications of these results for work with care staff, the analysis of challenging behaviors, and experimental research on rule-governed behavior are discussed.
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PMID:Adults' responses to self-injurious behavior. An experimental analysis using a computer-simulation paradigm. 748 65

To investigate the relationship between psychiatric disorders and severe behavior problems in mental retardation, statewide client databases from developmental disabilities services in California (N = 89,419) and New York (N = 45,683) were analyzed and juxtaposed. The study focussed on nine major DSM-III-R psychiatric categories (or their equivalents), and severe forms of aggressive behavior, property destruction, self-injurious behavior, and stereotyped behavior in individuals 45 years old and younger with mental retardation of all levels of severity. In California, 3.9% had at least one psychiatric diagnosis; in New York, 5.4%. The rate of specific psychiatric diagnoses was variable across states, suggesting local preferences in diagnostic practices. Severe behavior problems occurred in 22.1% in California and in 41.4% in New York. This difference in rates can be attributed in part to different recording criteria for behavior problems. With regard to the association between psychiatric diagnoses and problem behaviors the results were consistent across databases: No compelling correlations were found. This means that neither aggression, self-injury, destruction, nor stereotypies determine whether a person receives a psychiatric diagnosis or not.
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PMID:The association between psychiatric diagnoses and severe behavior problems in mental retardation. 790 16

The Dexamethasone Suppression Test (DST) was performed for three groups of institutionalized patients with mental retardation: (a) patients with symptoms of depression, (b) nondepressed patients with other problematic behavior (aggressiveness, self-injurious behavior, or withdrawal), and (c) control subjects with no behavioral or psychiatric symptoms. Results showed that depressed patients more frequently (though not significantly) had positive DSTs and significantly higher cortisol levels compared with the other two groups. Patients with other problematic behavior did not differ from control subjects. The DST may be particularly valuable in diagnosing depression in individuals with severe mental retardation, who are often nonverbal and unable to express depressive symptoms.
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PMID:The dexamethasone suppression test as an indication of depression in patients with mental retardation. 790 20

We report the results of an open trial of valproic acid in the treatment of affective symptoms in people with mental retardation. The study population consisted of 209 people with mental retardation who were serially referred to a tertiary-care medical center for the evaluation of behavioral symptoms. Criteria for treatment included the presence of three of the four following symptoms: irritability, sleep disturbance, aggressive or self-injurious behavior, and behavioral cycling. Twenty-one patients met enrollment criteria and were studied prospectively for a 2-year period. Two patients were lost to follow-up. One patient experienced severe drug side effects. Eighteen patients completed the study. Fourteen patients (78%) responded favorably to treatment and were maintained on valproic acid for the 2 years of the study (p < 0.001). Medications prescribed at the time of enrollment were usually discontinued, including neuroleptic medication in 9 of 10 patients and in all patients (N = 3) who were receiving phenobarbital. A history of epilepsy or a suspicion of seizures was strongly associated with a favorable response to valproic acid (p < 0.005). The results of this study suggest that people with mental retardation and concurrent affective disorders can be recognized by a cluster of developmentally appropriate symptoms such as those listed above. In addition, affective symptoms can be successfully treated with valproate with reductions in neuroleptic and barbiturate anticonvulsant medication. Further study of the comparative benefit of valproate and carbamazepine in this population is warranted.
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PMID:Long-term administration of valproic acid in the treatment of affective symptoms in people with mental retardation. 812 Jan 59


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